Defining Signs of Stress Versus Burnout Among Physicians with Sue Padernacht, EdD, PCC

In the January 2024 episode of Lungcast, Sue Padernacht, EdD, PCC, the CEO and founder of Ncline Leadership Strategies and American Lung Association (ALA) National Board Director, highlighted some of the differences between signs of stress and of burnout among physicians.

Padernacht, a professional certified coach who works on leadership assessment, and Lungcast host Albert Rizzo, MD, chief medical officer of the American Lung Association and HCPLive Editorial Advisory Board member, spoke on the topic of burnout and emphasized some very alarming concerns among clinicians with regard to the impacts of stress.

The conversation between Rizzo and Padernacht was informative, and may be considered timely given growing concerns about workplace stress and mental health issues.

Rizzo first noted that he had come across the important distinction between being stressed and being burned out, asking Padernacht to comment on the differences.

“I'm glad you brought that up, and truthfully the research is mixed on this,” Padernacht explained. “...There are constructs in which burnout is a subcategory of stress. And there's other research that would even say that, really, the overlap is so great that there isn't really a substantive difference to warrant a separate definition. So with all of that, I think that the work that was done up at Stanford does a really good job of parsing out some of the differences.”

In the end, Padernacht expressed that if one is unclear about whether one is stressed or burned out, stressing one’s self out about defining it is misplaced energy that should be put toward seeking mental health guidance.

Nevertheless, Padernacht explored some of the principal distinctions between both concepts so that physicians may understand both a bit better.

“So while the feelings of sadness can be associated with both burnout and stress, stress also tends to be associated with fear and anxiety in anticipation or in response to work, anticipating workplace stresses, or in response or reaction to surprises,” she said. “So stress is more of a high energy experience. It can also be quite performative.”

Eudaimonic stress is one form of stress highlighted by Padernacht, which she described as a ‘good stress.’ It is associated with high degrees of focus and engagement and readiness, which is associated with subjective well being.

“So distress, of course, is the bad stress associated with elevated cortisol levels, which I don't have to tell you or your audience,” Padernacht said. “But that's like termites on the body, the wear and tear on the body. That's in response to real or perceived environmental stressors. The immediate reaction to sudden change is really what distress is for. Those elevated cortisol levels are supposed to get us into that fight-or-flight activation of the amygdala.”

Padernacht explained that this is what distress is supposed to be for in moments of urgency. Yet if this is carried over a long period of time it can be overtaxing, where the body is overusing its internal resources.

“So at some point, there's an imbalance between our internal capacity and the demands of the external environment,” Paderncacht said. “So that's where that distress can lead into burnout, which now leads us into our definition of our distinction with burnout. So burnout is more of a low energy experience.”

Lungcast is a monthly respiratory health podcast series from the ALA produced by HCPLive.

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